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Persons handling radiation sources can minimize exposure to radiation by recognizing the importance of time, distance, and shielding Areas housing x-ray and nuclear materials must be properly shielded X-ray equipment should be periodically checked for reliability of output, and proper filters should be used When feasible, it is advisable to shield the gonads, especially of young persons Fluoroscopic procedures should be performed as rapidly as possible using an optimal combination of beam characteristics and filtration, and the beam size should be kept to a minimum required by the examination Special protective clothing may be necessary to protect against contamination with radioisotopes In the event of accidental contamination, all clothing should be removed and the body vigorously bathed with soap and water This should be followed by careful instrument (Geiger counter) check to localize the ionizing radiation These disorders may occur following excessive ionizing radiation exposure: skin scarring, atrophy, and telangiectasis; cataract, dry eye syndrome, retinopathy; neuropathy, myelopathy, cerebral injury; obliterative endarteritis, coronary artery disease, pericarditis; thyroid disease; pulmonary fibrosis, hepatitis, intestinal stenosis, nephritis, and chromosomal aberrations Neoplastic disease, including leukemia and cancers of the skin, breast, lung, and thyroid, is increased in persons exposed to radiation at relatively low doses (< 02 Gy) High-dose radon exposure is associated with an increased risk of lung cancer Association of ionizing radiation with several other cancers has been reported but not well quantified (salivary glands, skin, stomach, colon, bladder, ovary, and central nervous system) Prenatal irradiation may increase the risk of childhood cancer Microcephaly and other congenital abnormalities may occur in children exposed in utero, especially if the fetus was exposed during early pregnancy Carcinogenesis from lowdose (50 100 mSv/5 10 rem) exposure to adults probably

occurs, but risk is proportional to total dose Age-related differences in sensitivity to radiation have also resulted in carcinogenesis following childhood exposures (eg, Chernobyl and childhood thyroid cancer)

Brenner DJ et al Cancer risks attributable to low doses of ionizing radiation: Assessing what we really know Proc Natl Acad Sci U S A 2003 Nov 25;100(24):13761 6 [PMID: 14610281] Burnham JW et al Radiation Crit Care Clin 2005 Oct;21(4): 785 813 [PMID: 16168315] Koenig KL et al Medical treatment of radiological casualties: current concepts Ann Emerg Med 2005 Jun;45(6):643 52 [PMID: 15940101] Radiation Emergency Assistance Center/Training Site (REACTS) wwworaugov/reacts Waselenko JK et al; Strategic National Stockpile Radiation Working Group Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group Ann Intern Med 2004 Jun 15;140(12):1037 51 [PMID: 15197022]

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The CTyp column shows the condition type This is the backbone of the pricing procedure The condition type is the link, as you know, to the access sequence all the way to the actual condition record When you enter a condition type, the description field is filled automatically with the description from the condition type If you wish to enter a sub-total or total, no condition type applies In this case, you can enter a description without a condition type for example, net price The From and To columns are used in two circumstances: To define the range for a subtotal For example, if you want to add up all the conditions types from step 10 to 50, you would enter 10 and 50 in the From and To columns, respectively To define the basis for a calculation For example, if a discount is defined as a percentage, you need to indicate which step must be used as the basis for the calculation If the calculation must be performed on step 100, you would enter 100 in the From field The Man column (for Manual ) is used to indicate if the condition type for which it is assigned to is allowed to be processed automatically or only manually

Many other patients respond promptly to immediate ventilation Other patients, with more severe degrees of near drowning, may have frank respiratory failure, pulmonary edema, shock, anoxic encephalopathy, cerebral edema, and cardiac arrest A few patients may be deceptively asymptomatic during the recovery period only to deteriorate or die as a result of acute respiratory failure within the following 12 24 hours

The patient may be unconscious, semiconscious, or awake but apprehensive, restless, and complaining of headaches or chest pain Vomiting is common Examination may reveal cyanosis, trismus, apnea, tachypnea, and wheezing A pink froth from the mouth and nose indicates pulmonary edema Cardiovascular manifestations may include tachycardia, arrhythmias, hypotension, cardiac arrest, and circulatory shock With prolonged or cold water immersion, hypothermia is likely

Urinalysis shows proteinuria, hemoglobinuria, and acetonuria Leukocytosis is usually present The PaO2 is usually decreased and the PaCO2 increased or decreased The blood pH is decreased as a result of metabolic acidosis Chest radiographs may show pneumonitis or pulmonary edema

Prevention consists of avoidance of alcohol during recreational swimming or boating, close supervision of toddlers, swimming lessons early in life, and use of personal flotation devices when boating All swimming pools should be fenced

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